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1.
Int Heart J ; 60(5): 1106-1112, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484874

RESUMO

A useful biomarker for detecting cardiac amyloidosis (CA) has not been fully established. We aimed to investigate the utility of several biomarkers to detect CA in patients with amyloid light-chain (AL) amyloidosis.We examined the plasma levels of B-type natriuretic peptide (BNP), N-terminal fragment of the pro-brain natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), serum amyloid A, and the difference between kappa and lambda free light chain (dFLC) between CA patients (n = 30, 47.6%) and non-CA patients (n = 33, 52.4%). Levels of BNP were significantly higher in the CA group compared to the non-CA group (1200.0 versus 224.0 pg/mL, P = 0.001). From the ROC analysis, the sensitivity and specificity of BNP for detecting CA (with a cut-off value of 412 pg/mL) were 83% and 70%, respectively, and the area under the receiver operating curve was 0.75 (95% CI 0.61-0.90, P < 0.001) in all AL amyloidosis patients (n = 63). In contrast, other markers such as NT-proBNP, hs-cTnT, serum amyloid A, and dFLC were not useful for detecting CA in AL amyloidosis patients. Additionally, in the Cox proportional hazard analysis, BNP was a predictor of all-cause mortality (hazard ratio 3.266, 95% confidence interval 1.498-7.119, P = 0.003).BNP is a useful biomarker for detecting cardiac involvement and predicting prognosis in AL amyloidosis patients.


Assuntos
Cardiopatias/sangue , Cardiopatias/epidemiologia , Amiloidose de Cadeia Leve de Imunoglobulina/sangue , Peptídeo Natriurético Encefálico/sangue , Troponina T/sangue , Idoso , Biomarcadores/sangue , Causas de Morte , Estudos de Coortes , Progressão da Doença , Ecocardiografia Doppler/métodos , Eletrocardiografia/métodos , Feminino , Cardiopatias/diagnóstico por imagem , Hospitais Universitários , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina/fisiopatologia , Japão , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida
2.
Br J Anaesth ; 123(5): 565-569, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31547970

RESUMO

This case series presents 10 patients undergoing vascular surgery with asymptomatic elevated high-sensitivity troponin T concentrations, measured at outpatient clinic before surgery. Patients were included in the RAVE (Rotterdam Antiplatelet therapy in Vascular patiEnts) pilot study. All included patients underwent coronary angiography before surgery to identify significant obstructive coronary artery disease. We identified five out of 10 patients with high-grade stenosis and high-risk angiographic features of left main and/or proximal left anterior descending coronary artery disease. The study was terminated prematurely before any subject reached the study endpoint of 1 yr follow-up. This case series provides more insight into the meaning of preoperative troponin elevation and coronary angiographic features in vascular surgery patients. TRIAL REGISTRY NUMBER: NL5803.


Assuntos
Angiografia Coronária/métodos , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Cuidados Pré-Operatórios/métodos , Troponina T/sangue , Procedimentos Cirúrgicos Vasculares , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/cirurgia , Método Duplo-Cego , Feminino , Humanos , Masculino , Projetos Piloto , Fatores de Risco
3.
Acta Clin Croat ; 58(1): 95-102, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31363330

RESUMO

The aim of this study was to assess the efficacy of high-sensitivity C-reactive protein (hsCRP), cardiac troponin T (cTnT) and creatine kinase (CK) as long-term predictors of reduced systolic function in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) with complete revascularization. This prospective study evaluated consecutive patients with acute STEMI who had normal left ventricular ejection fraction (LVEF ≥50%) at admission with single-vessel disease and underwent complete revascularization. Blood samples were collected from admission to day 7. The primary endpoint was reduction of LVEF <50% after 12 months. The study included 47 patients, median age 59±10 years, 74.5% of them men. Patients who developed systolic dysfunction (LVEF <50%) had significantly higher mean values of cTnT after 24 hours (5.11 vs. 2.82 µg/L, p=0.010) and peak values of CK (3375.5 vs. 1865 U/L, p=0.008). There was no significant relation between hsCRP and development of reduced LVEF (p=0.541). In conclusion, cTnT and CK could serve as long-term predictors of reduced left ventricular systolic function (<50%) in acute STEMI patients with normal systolic function at admission, single-vessel coronary disease and complete revascularization during primary PCI.


Assuntos
Proteína C-Reativa/análise , Creatina Quinase Forma MB/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/metabolismo , Troponina T/sangue , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Tempo , Função Ventricular Esquerda
4.
Niger J Clin Pract ; 22(7): 997-1001, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31293267

RESUMO

Background: In this study, postoperative cardiac functions were observed in patients undergoing coronary artery bypass grafting (CABG) surgery following preoperative administration of the anti-ischemic drug trimetazidine. Materials and Methods: The study included a total of 50 CABG patients; 25 were administered with trimetazidine preoperatively and 25 did not receive trimetazidine. A retrospective evaluation was made of the parameters of age, gender, preoperative echocardiography (ECHO) results, cross-clamping durations, postoperative inotropic requirements, and postoperative 4th-h troponin-I levels and the groups were compared. Results: There was no statistically significant difference determined between the 2 groups in respect of the data of age, gender, comorbidity, preoperative ECHO signs [(ejection fraction (EF), left ventricle end systolic diameter (lvsd), left ventricle end diastolic diameter (lvdd), left atrium diameter (LA), and intraventricular septum thickness (IVS)], inotropic requirements, and postoperative troponin-I levels. In the control group, a positive correlation was determined between postoperative troponin-I levels and DM (r: 0.597, p: 0.002). There was no correlation determined in the trimetazidine group (r:-0.042, p: 0.844). Conclusion: The results of this study demonstrated a positive correlation between postoperative troponin-I levels and DM in the group not administered with trimetazidine. There was no such correlation determined in the group administered with trimetazidine. This result may suggest that DM may increase troponin-I levels in the absence of trimetazidine, and therefore that the drug may be cardioprotective in such cases. Further studies on more extensive patient populations are required to confirm these results.


Assuntos
Ponte de Artéria Coronária , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Cuidados Pré-Operatórios , Trimetazidina/administração & dosagem , Trimetazidina/uso terapêutico , Troponina T/sangue , Vasodilatadores/uso terapêutico , Idoso , Ponte de Artéria Coronária/métodos , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos
6.
Biochem Med (Zagreb) ; 29(2): 020902, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31223266

RESUMO

Introduction: Difference between high-sensitivity cardiac troponin T concentrations (hs-cTnT) before and after ablation procedure (delta concentration) reflects the amount of myocardial injury. The aim of the study was to investigate hs-cTnT prognostic power for predicting atrial fibrillation (AF) recurrence after repeat pulmonary vein isolation (PVI) procedure. Materials and methods: Consecutive patients with paroxysmal AF undergoing repeat PVI using a focal radiofrequency catheter were included in the study. Hs-cTnT was measured before and 18-24 hours after the procedure. Standardized 3, 6 and 12-month follow-up was performed. Cox-regression analysis was used to identify predictors of AF recurrence. Results: A total of 105 patients undergoing repeat PVI were analysed (24% female, median age 61 years). Median (interquartile range) hs-cTnT delta after repeat PVI was 283 (127 - 489) ng/L. After a median follow-up of 12 months, AF recurred in 24 (23%) patients. A weak linear relationship between the total radiofrequency energy delivery time and delta hs-cTnT was observed (Pearson R2 = 0.31, P = 0.030). Delta Hs-cTnT was not identified as a significant long-term predictor of AF recurrence after repeated PVI (P = 0.920). Conclusion: This was the first study evaluating the prognostic power of delta hs-cTnT in predicting AF recurrence after repeat PVI. Delta hs-cTnT does not predict AF recurrence after repeat PVI procedures. Systematic measurement of hs-cTnT after repeat PVI does not add information relevant to outcome.


Assuntos
Fibrilação Atrial , Doenças Cardiovasculares/sangue , Veias Pulmonares/metabolismo , Troponina T/sangue , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
7.
Biochem Med (Zagreb) ; 29(2): 021001, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31223267

RESUMO

Introduction: Measurement of high-sensitivity troponin T (hs-TnT) has become an essential step in the diagnosis of acute myocardial infarction. This high-sensitivity method allows quantifying the concentration of troponin T in blood of healthy subjects with a lower inaccuracy compared to previous reagent generations. However, the presence of certain compounds in the sample may interfere with the result. We present a patient who had repeatedly high concentrations of hs-TnT in the serum sample that did not agreed with the signs and symptoms. In addition, ultrasensitive troponin I concentration was undetectable. Materials and methods: To investigate the presence of an interfering compound, different analysis were carried out. In order to discard macro complexes in the sample, the serum was precipitated with polyethylene glycol. In addition, the serum was incubated with Scantibodies Heterophilic Blocking Tube, which can block heterophilic antibodies. Finally, a size exclusion chromatography of the sample was performed by the manufacturer. What happened: The interfering substance was allocated into fractions with proteins of 150kDa, corresponding to high molecular weight proteins like immunoglobulin G (IgG). This compound was responsible for the falsely elevated hs-TnT results and it affected only the high-sensitivity methods. Main lesson: The detected interfering compound was probably an IgG. This type of interference must be kept in mind in front of discordant results, even if they are extremely rare. Therefore, interdisciplinary cooperation between clinicians, laboratory and manufacturer is essential.


Assuntos
Troponina T/sangue , Criança , Humanos , Masculino , Polietilenoglicóis/química , Sensibilidade e Especificidade
8.
Clin Biochem ; 73: 35-43, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31247187

RESUMO

BACKGROUND: Cardiac troponin (cTn) is a complex of three subunits (T, I, and C), with some studies reporting that ~5-10% is cytosolic and unbound ('free'). It has been hypothesized that free cTn is released before complex and before or without cell death dependent on the severity of ischemia. In this context, new generation assays that can discriminate free, binary (IC) and ternary (TIC) complex forms may aid to differentiate between type 1 myocardial infarction (MI) and cTn elevations due to different etiologies, e.g. demand ischemia and type 2 MI. METHODS: Serial plasma samples from six type 1 MI patients and twenty-seven patients with other cTnI elevations, e.g. due to demand ischemia and type 2 MI, were analyzed using high-sensitivity ET Healthcare Pylon assays for total cTnI, complex cTnI (IC and TIC), and cTnTIC. The specificity of the anti-cTnT antibody in the cTnTIC assay was such that only full-size cTnTIC is detected. In vitro stability of different cTnI forms was assessed by spiking free cTnI and cTnTIC in cTnI-free serum, incubating at 4 or 37 °C, and measuring different cTnI forms over 0-182 h. Presence of cytosolic free cTnI was evaluated on fixed rat cardiac tissue using an antibody against free cTnI. RESULTS: Pylon assays for total and complex cTnI tracked well over time with each other and gave similar results, both for type 1 MI and non-type 1 MI patients, indicating that the vast majority was complex cTnI. As a minority of complex cTnI was full-size cTnTIC, this indicated that complex cTnI mainly consisted of a degraded form of cTnTIC (low-molecular weight cTnTIC) and/or cTnIC. Full-size cTnTIC was more abundant in early compared to late samples. In vitro studies indicated that free cTnI and cTnTIC are not stable at 37 °C (28% and 11% recovery after 24 h, respectively) and this is also true to some extent for cTnTIC at 4 °C (60% recovery after 24 h). Free cTnI was not readily detected in rat cardiac tissue. CONCLUSIONS: In agreement with type 1 MI, cTnI in samples of patients with cTnI elevations due to other etiologies is found predominantly as complex cTnI, of which some is full-size cTnTIC. In most cases, assays for total and complex cTnI indicated there was little free cTnI; however, its presence cannot be completely excluded, due to the inability of its direct measurement and limited stability.


Assuntos
Infarto do Miocárdio/sangue , Miocárdio/metabolismo , Troponina I/sangue , Troponina T/sangue , Animais , Linhagem Celular , Feminino , Humanos , Masculino , Infarto do Miocárdio/classificação , Ratos , Ratos Nus
9.
Chin Med J (Engl) ; 132(12): 1390-1399, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31205095

RESUMO

BACKGROUND: Mental stress-induced myocardial ischemia (MSIMI) is closely associated with adverse cardiac events in patients with coronary artery disease (CAD) and we aimed to determine whether biomarkers and blood pressure could be potential predictors of MSIMI. METHODS: This study enrolled 82 patients with documented CAD between June 1, 2017 and November 9, 2017. Patient blood samples were obtained at resting period and at the end of mental arithmetic. Then, patients were assigned to MSIMI positive group and MSIMI negative group. The main statistical methods included linear regression, receiver operating characteristic (ROC) curves, and logistic regression. RESULTS: Patients with CAD with MSIMI had significantly greater median resting N-terminal pro-brain natriuretic peptide (NT-proBNP, 141.02 [45.85-202.76] pg/mL vs. 57.95 [27.06-117.64] pg/mL; Z = -2.23, P = 0.03) and mean systolic blood pressure (SBP) (145.56 ±â€Š16.87 mmHg vs. 134.92 ±â€Š18.16 mmHg, Z = -2.13, P = 0.04) when compared with those without MSIMI. After 5-min mental stress task, those who developed MSIMI presented higher elevation of median post-stressor high sensitivity cardiac troponin I (hs-cTnI, 0.020 [0.009-0.100] ng/mL vs. 0.009 [0.009-0.010] ng/mL; Z = -2.45, P = 0.01), post-stressor NT-proBNP (138.96 [39.93-201.56] pg/mL vs. 61.55 [25.66-86.50] pg/mL; Z = -2.15, P = 0.03) compared with those without MSIMI. Using the ROC curves, and after the adjustment for basic characteristics, the multiple logistic regression analysis showed that patients presenting a post-stressor hs-cTnI ≥ 0.015 ng/mL had seven-fold increase in the risk of developing MSIMI (odds ratio [OR]: 7.09; 95% confidence interval [CI]: 1.65-30.48; P = 0.009), a rest NT-proBNP ≥ 80.51 pg/mL had nearly eight-fold increase (OR: 7.85; 95% CI: 1.51-40.82; P = 0.014), a post-stressor NT-proBNP ≥ 98.80 pg/mL had 35-fold increase (OR: 34.96; 95% CI: 3.72-328.50; P = 0.002), a rest SBP ≥ 129.50 mmHg had 11-fold increase (OR: 11.42; 95% CI: 1.21-108.17; P = 0.034). CONCLUSIONS: The present study shows that CAD patients with higher hs-cTnI level, and/or greater NT-proBNP and/or SBP are at higher risk of suffering from MSIMI when compared with those without MSIMI, indicating that hs-cTnI, NT-proBNP, SBP might be potential predictors of MSIMI.


Assuntos
Doença da Artéria Coronariana/complicações , Isquemia Miocárdica/etiologia , Estresse Psicológico/complicações , Idoso , Ansiedade/sangue , Ansiedade/complicações , Biomarcadores/sangue , Pressão Sanguínea/fisiologia , Proteína C-Reativa/metabolismo , Doença da Artéria Coronariana/sangue , Depressão/sangue , Depressão/complicações , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/sangue , Peptídeo Natriurético Encefálico/sangue , Razão de Chances , Fragmentos de Peptídeos/sangue , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Estresse Psicológico/sangue , Tomografia Computadorizada de Emissão de Fóton Único , Troponina I/sangue , Troponina T/sangue
10.
Life Sci ; 232: 116547, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31176780

RESUMO

AIMS: This study aims to investigate the value of the expression of miR-208, miR-494, miR-499 and miR-1303 in the early diagnosis of acute myocardial infarction (AMI). MAIN METHODS: Patients were divided into two groups: AMI group (n = 41), and Stable angina pectoris (SAP) group (n = 32). Peripheral venous blood was sampled from these patients at the time of admission (T0), 6 h after onset (T6) and 12 h after onset (T12), while blood was sampled once from healthy subjects who underwent physical examination in the same time period (control group, n = 10). The expression of miR-208, miR-494, miR-499 and miR-1303 in serum were detected by real-time quantitative polymerase chain reaction (qRT-PCR), and differences in miRNA expression among these three groups of patients were analyzed. KEY FINDINGS: Serum miR-208, miR-494, miR-499 and miR-1303 expression levels at different time points were significantly higher in the AMI group than in the SAP group and control group. The differences among these groups were statistically significant (P < 0.05), while the difference between the SAP group and control group was not statistically significant (P > 0.05). Variation trend: The miRNA levels above began to increase at T0 in the AMI group, the peak levels of miR-208, miR-494 and miR-499 appeared before T12, and the peak level of miR-1303 appeared between T6 and T12, or after T12. SIGNIFICANCE: miR-208, miR-494, miR-499 and miR-1303 were not superior to hs-cTnI as myocardial markers in the diagnosis of early acute myocardial infarction.


Assuntos
MicroRNAs/genética , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/genética , Idoso , Angina Estável/genética , Angina Estável/metabolismo , Biomarcadores/sangue , Estudos de Casos e Controles , Diagnóstico Precoce , Feminino , Humanos , Masculino , MicroRNAs/análise , Pessoa de Meia-Idade , Curva ROC , Reação em Cadeia da Polimerase em Tempo Real , Transcriptoma/genética , Troponina I/análise , Troponina I/sangue , Troponina T/análise , Troponina T/sangue
11.
Clin Chim Acta ; 495: 522-528, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31152695

RESUMO

BACKGROUND: We report the analytical performance of the Elecsys® Troponin T Gen 5 STAT (TnT Gen 5 STAT; Roche Diagnostics) assay. METHODS: Measuring limits/ranges were determined in lithium-heparin plasma samples per Clinical and Laboratory Standards Institute (CLSI) EP17-A2. Precision was evaluated per CLSI EP05-A2 using lithium-heparin plasma/quality control samples on cobas e 411/cobas e 601 analyzers; two duplicated runs per day for 21 days (n = 84). Cross-reactivity with other troponin forms and interference from endogenous substances/drugs was tested; recovery criterion for no cross-reactivity was within ±10%. RESULTS: Coefficients of variation (CV) for repeatability/intermediate precision were 0.7-5.6%/1.4-10.3% (cobas e 411; mean cardiac troponin T [cTnT]: 7.3-9341 ng/L) and 0.7-3.0%/1.5-6.4% (cobas e 601; mean cTnT: 7.4-9455 ng/L). There was no cross-reactivity with skeletal muscle troponin T (≤ 10,000 ng/L), skeletal muscle troponin I (≤ 100,000 ng/L), cardiac troponin I (≤ 10,000 ng/L), or human troponin C (≤ 80,000 ng/L). No interference was observed with biotin (≤ 20 ng/mL) or 34 drugs. CONCLUSION: The TnT Gen 5 STAT assay demonstrated a CV of <10% at the 99th percentile upper reference limit, meeting precision requirements (Fourth Universal Definition of Myocardial Infarction) for high-sensitivity troponin assays.


Assuntos
Análise Química do Sangue/métodos , Imunoensaio/métodos , Troponina T/sangue , Humanos , Limite de Detecção , Medições Luminescentes , Reprodutibilidade dos Testes
12.
Clin Chim Acta ; 495: 507-511, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31152696

RESUMO

BACKGROUND: The pneumatic tube system (PTS) is widely established in clinical laboratories. We aimed to evaluate the impacts of PTS on high-sensitivity cardiac troponin T (hs-cTnT) assays. METHODS: The hemolysis distribution of hs-cTnT PTS specimens from emergency department (ED) were determined by hemolysis index (HI). Grouped samples from 15 healthy volunteers were delivered to the laboratory via manual delivery (MD) or PTS. Interference studies were conducted to access the influence of different hemolysis degrees on hs-cTnT assays. RESULTS: 7.26% PTS specimens from ED were hemolyzed in clinic. Compared with MD samples, we found highly elevated free plasma hemoglobin (Hb) in PTS samples. Hs-cTnT was interfered negatively with free Hb (R = -0.625, P < .001), and it was also validated in interference studies (R ≥ -0.820, all P ≤ .001). Clinically significant bias occurred in each hs-cTnT concentration at 100 mg/dl free Hb (Bias≥ - 13.85%, all P < .05). Moreover, bias of hs-cTnT assays at 50 mg/dl free Hb was approaching 10%, especially at 30 ng/l hs-cTnT concentration (Bias: -11.72%, P < .001). CONCLUSIONS: PTS could increase the frequency of specimen hemolysis which might cause false decrease in hs-cTnT assays. Hence, clinicians should be aware of the increased measurement bias in hs-cTnT from hemolyzed PTS samples with free Hb ≥50 mg/dl.


Assuntos
Análise Química do Sangue/instrumentação , Limite de Detecção , Miocárdio/metabolismo , Troponina T/sangue , Reações Falso-Negativas , Feminino , Voluntários Saudáveis , Humanos , Masculino , Troponina T/metabolismo , Adulto Jovem
13.
Niger J Clin Pract ; 22(5): 598-602, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31089012

RESUMO

Objective: The aim of this study was to determine the effectiveness of hematological parameters measured at the moment of admission to the emergency room in predicting in-hospital mortality and to determine cut-off values of strongly predictive values. Subjects and Methods: The study began with approval of the ethics committee. In total, 1,929 patients over 18 years of age, whose date could be obtained, were included in the study. From the hemogram parameters, white blood cells (WBC), red cell distribution width, mean platelet volume, and ratio of neutrophils to lymphocytes (NLR) values were determined and recorded. CK-MB and high-sensitive Troponin T values were recorded as cardiac markers. For statistical analysis, "SPSS for Windows Version 21" package program was used. Findings: About 71.7% (n = 1384) of the patients were male and 28.3% (n = 545) of the patients were female. About 92.5% of the patients (n = 1785) were discharged from the hospital, whereas the remaining 144 patients (7.5%) were exitus in the hospital. When the efficacy of hematological parameters and cardiac markers in predicting mortality was examined by receiver operating charecteristics analysis, NLR was found to be the strongest predictor (area under the curve [AUC], 0.772, standard deviation [SD] = 0.022, 95% confidence interval [CI]). It was found that the WBC value came in second place after NLR as a strong predictor of mortality (AUC, 0.749, SD = 0.024, % 95 CI). Conclusion: The use of predictors for the prediction of mortality for ST elevation myocardial infarction patients is of great importance for faster implementation of treatment modalities. We found that WBC and especially NLR values obtained with a simple method can be used as powerful predictors.


Assuntos
Mortalidade Hospitalar , Linfócitos , Neutrófilos , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Idoso , Área Sob a Curva , Creatina Quinase Forma MB/sangue , Índices de Eritrócitos , Feminino , Humanos , Contagem de Linfócitos , Masculino , Volume Plaquetário Médio , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Troponina T/sangue
14.
J Vet Emerg Crit Care (San Antonio) ; 29(3): 256-263, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31034737

RESUMO

OBJECTIVE: To measure plasma N-terminal fragments of pro-B-type natriuretic peptides (NT-proBNP) and cardiac troponin T (cTnT) concentration in hospitalized dogs and relate these markers to underlying conditions and evaluate their potential as prognostic markers in dogs with systemic inflammatory response syndrome (SIRS). DESIGN: Prospective, observational, clinical study. SETTING: Emergency department of a university teaching hospital. ANIMALS: Sixty-nine dogs with SIRS examined in the emergency department were prospectively studied. Patient age ranged from 5 months to 15 years, and weight ranged from 5.5 to 75 kg. MEASUREMENTS AND MAIN RESULTS: Blood samples were obtained at presentation, during hospitalization until discharge or death, and at a "control" visit (T1m) at least 1 month after hospital discharge. NT-proBNP was assayed with a commercially available canine ELISA, while cTnT was measured with an automated immunoassay previously used in dogs. A correlation procedure, mixed procedure on a linear model, and a logistic procedure were performed. Forty-four patients survived, 19 of which had control visits. cTnT concentrations were significantly higher than T0 and T1m at T12, T24, and T72. In 28 dogs, cTnT was detected during hospitalization, but cTnT was not detected in any dog at the control visits. Higher concentrations of cTnT were negatively associated with survival, irrespective of disease category. NT-proBNP concentrations were significantly higher than T0, T6, T12, and T1m at T24, T72, and T120, but were not associated with survival. CONCLUSIONS: NT-proBNP and cTnT increased significantly in dogs with SIRS, regardless of the underlying disease process. Nonsurvivors displayed significantly higher cTnT concentrations during hospitalization.


Assuntos
Biomarcadores/sangue , Doenças do Cão/sangue , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Síndrome de Resposta Inflamatória Sistêmica/veterinária , Troponina T/sangue , Animais , Cuidados Críticos , Cães , Feminino , Masculino , Prognóstico , Estudos Prospectivos , Síndrome de Resposta Inflamatória Sistêmica/sangue
15.
J Clin Neurosci ; 64: 145-149, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30929959

RESUMO

Our objective was to assess the impact of hs-cTnT elevation on functional outcome and mortality in AIS patients with large vessel occlusion (LVO) in the anterior circulation 3 months after ET and explore factors affecting hs-cTnT elevation. A total of 143 consecutive AIS patients with large vessel occlusion (LVO) in the anterior circulation following ET in a single stroke center were enrolled between January 2015 and November 2017. Hs-cTnT was quantitated on admission. Demographic characteristics, clinical data, functional outcome and all-cause mortality were compared between patients with elevated hs-cTnT levels (>14 ng/L) and those with normal hs-cTnT levels (≤14 ng/L). 58/143(40.6%) patients showed elevated hs-cTnT levels before ET. Factors independently associated with hs-cTnT elevation were admission NIHSS score (OR = 1.08, 95% CI 1.01-1.16, p = 0.032), coronary heart disease (OR = 4.89, 95% CI 1.82-13.11, p = 0.002) and congestive heart failure (OR = 4.10, 95% CI 1.07-15.68, p = 0.039). In the univariate analysis, patients with elevated hs-cTnT levels were at significantly higher risk of 3-month poor outcome (p = 0.029) and mortality (p < 0.001) than those with normal hs-cTnT levels. After multivariable analysis, hs-cTnT elevation remained an independent predictor of 3-month mortality (OR = 4.49, 95% CI 1.68-11.98, p = 0.003). In this cohort of AIS patients with LVO in the anterior circulation undergoing ET, hs-cTnT elevation is an independent predictor of 3-month mortality. Admission NIHSS score, coronary heart disease and congestive heart failure are independently associated with elevated hs-cTnT levels.


Assuntos
Biomarcadores/sangue , Acidente Vascular Cerebral/cirurgia , Troponina T/sangue , Idoso , Isquemia Encefálica/sangue , Isquemia Encefálica/mortalidade , Isquemia Encefálica/cirurgia , Estudos de Coortes , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/mortalidade , Trombectomia/métodos , Trombectomia/mortalidade
16.
Clin Lab ; 65(4)2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30969071

RESUMO

BACKGROUND: Cardiac troponin I (TnI) is one of the most crucial biomarkers for the management of acute coronary syndrome. However, the TnI values can vary when using commercial TnI assays from different vendors. We assessed the feasibility of TnI harmonization using plasma and serum samples. METHODS: Leftover plasma and serum samples were collected from patients and stored for further analysis (n = 200). TnI measurements were performed using 3 different analyzers. The TnI values for plasma and serum were compared, and the mathematical recalibration was performed using the mean of 3 values from each analyzer as a reference value. The number of biased cases was counted before and after recalibration. RESULTS: The final analysis was performed in a total of 140 plasma and serum samples, and constant and/or proportional differences for each analyzer were observed. Mathematical recalibration of the TnI values resulted in improved correlation to the reference values. The number of TnI values that were remote from the reference values decreased after recalibration. The effects were more evident for serum samples. CONCLUSIONS: In this study, we reassured the possibility of TnI harmonization among 3 different immunoassays using plasma and serum samples. It is important to note the differences between sample types during TnI harmonization.


Assuntos
Biomarcadores/sangue , Técnicas de Laboratório Clínico/instrumentação , Técnicas de Laboratório Clínico/métodos , Imunoensaio/normas , Plasma , Soro , Troponina I/sangue , Síndrome Coronariana Aguda/sangue , Calibragem , Humanos , Modelos Teóricos , Infarto do Miocárdio/sangue , Valores de Referência , Troponina T/sangue
17.
Clin Biochem ; 67: 7-11, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30872042

RESUMO

OBJECTIVE: To evaluate the long term biological variation of high-sensitivity cardiac troponin T (hs-cTnT) in stable outpatients with cardiovascular disease (CVD). METHODS: After applying 8 exclusion criteria to 965 patients, hs-cTnT was measured at index visit and at a 12-month interval in 169 stable outpatients presenting for routine follow-up visits for any CVD. Stability was defined as absence of any endpoint within the follow-up period. Reference change values (RCVs) and minimal important differences (MIDs) were determined to assess biological variation of hs-cTnT. RESULTS: MID and RCV for the 12 months interval in patients were 3.8 ng/L or 44.2%, respectively. MID and transformed MID values were lower than the corresponding RCV with a value of 5.1 ng/L for the transformed RCV and 28.1% for the transformed MID. Similar patterns were shown in different subgroups as sex, age, and renal function. We observed a baseline hs-cTnT value dependent change of MID and RCV with increasing values for MID and decreasing values for RCV which converge to stable values between a baseline hs-cTNT value of 11 to 25 ng/L. CONCLUSIONS: Biological variation of hs-cTnT over 12 months in stable outpatients depends on the concentration at index visit, and is consistent among important prespecified subgroups. MID shows a low biovariability over 12 months. Clinical Trials Identifier:NCT01954303.


Assuntos
Doenças Cardiovasculares/sangue , Pacientes Ambulatoriais , Troponina T/sangue , Idoso , Idoso de 80 Anos ou mais , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Fatores de Tempo
18.
Rev Bras Ter Intensiva ; 31(1): 93-105, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30843948

RESUMO

Cardiac troponins T and I are considered highly sensitive and specific markers for the diagnosis of acute myocardial infarction. Currently, a series of nonprimary cardiac abnormalities may manifest as an elevation in high-sensitive assays. The reduction in their detection limits has allowed earlier diagnosis and the use of evidence-based therapeutic measures; however, this characteristic has increased the spectrum of detectable noncoronary heart diseases, which poses challenges for characterizing acute coronary syndromes and creates a new role for these tests in known disorders in intensive care units, especially sepsis. Management of patients through a greater understanding of how these markers behave should be re-evaluated to ensure their correct interpretation.


Assuntos
Cardiopatias/diagnóstico , Troponina I/sangue , Troponina T/sangue , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/diagnóstico , Biomarcadores/sangue , Diagnóstico Precoce , Cardiopatias/sangue , Humanos , Unidades de Terapia Intensiva , Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Sensibilidade e Especificidade
19.
Clin Chim Acta ; 495: 1-7, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30910596

RESUMO

INTRODUCTION: Chest pain and its clinical manifestations are the most common reasons for presentation to the emergency department (ED). Given that the prevalence of chest pain due to acute myocardial infarction (AMI) in the ED is modest, clinicians should use cardiac troponins to safely and rapidly rule out AMI, avoiding the delayed release of low risk patients. The study aims to develop and validate an algorithm to early rule-out of non-ST elevation myocardial infarction (NSTEMI) in subjects admitted to the ED with symptoms of myocardial infarction. METHODS: High sensitivity cardiac Troponin T (hs-cTnT) serial measurements (baseline, T0; after 1 h, T1; after 3 h, T3) were used to develop and validate the algorithm, respectively, in 6403 and 773 consecutive admissions suggestive of AMI. RESULTS: Patients were classified as having or not having NSTEMI according to clinical assessment, diagnostic imaging, and serial measurements ofhs-cTnT; ROC curve analysis allowed to find changes in consecutive hs-cTnT associated with diagnostic sensitivity close to 100%. Only patients with hs-cTnTat T0 lower than 14 ng/L resultedto be eligible for the safe rule-out of NSTEMI. CONCLUSIONS: Although some points remain to be improved, the results obtained indicate that algorithms for fast NSTEMI rule-out are feasible and safe.


Assuntos
Algoritmos , Análise Química do Sangue/métodos , Serviço Hospitalar de Emergência , Limite de Detecção , Infarto do Miocárdio sem Supradesnível do Segmento ST/sangue , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Troponina T/sangue , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Curva ROC , Fatores de Tempo
20.
Clin Chim Acta ; 493: 156-161, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30826369

RESUMO

BACKGROUND: The Italian Society of Clinical Biochemistry (SIBioC) and the Italian Section of the European Ligand Assay Society (ELAS) have recently promoted a multicenter study (Italian hs-cTnI Study) with the aim to accurately evaluate analytical performances and reference values of the most popular cTnI methods commercially available in Italy. The aim of this article is to report the results of the Italian hs-cTnI Study concerning the evaluation of the 99th percentile URL and reference change (RCV) values around the 99th URL of the Access cTnI method. MATERIALS AND METHODS: Heparinized plasma samples were collected from 1306 healthy adult volunteers by 8 Italian clinical centers. Every center collected from 50 to 150 plasma samples from healthy adult subjects. All volunteers denied the presence of chronic or acute diseases and had normal values of routine laboratory tests (including creatinine, electrolytes, glucose and blood counts). An older cohort of 457 adult subjects (mean age 63.0 years; SD 8.1 years, minimum 47 years, maximum 86 years) underwent also ECG and cardiac imaging analysis in order to exclude the presence of asymptomatic cardiac disease. RESULTS AND CONCLUSIONS: The results of the present study confirm that the Access hsTnI method using the DxI platform satisfies the two criteria required by international guidelines for high-sensitivity methods for cTn assay. Furthermore, the results of this study confirm that the calculation of the 99th percentile URL values are greatly affected not only by age and sex of the reference population, but also by the statistical approach used for calculation of cTnI distribution parameters.


Assuntos
Técnicas de Imagem de Sincronização Cardíaca/normas , Eletrocardiografia/normas , Troponina I/sangue , Troponina T/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Voluntários Saudáveis , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Valores de Referência , Adulto Jovem
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